Health economic evaluation of rivaroxaban in the treatment of patients with chronic coronary artery disease or peripheral artery disease

Abstract

Aims: In the COMPASS trial, rivaroxaban 2.5 mg twice daily (bid) plus acetylsalicylic acid (ASA) 100 mg once daily (od) performed better than ASA 100 mg od alone in reducing the rate of cardiovascular disease, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was developed to assess the cost-effectiveness of rivaroxaban plus ASA vs. ASA alone over a lifetime horizon, from the UK National Health System perspective.

Methods and results: The base case analysis assumed that patients entered the model in the event-free health state, with the possibility to experience ≤2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life-years (QALYs), life years-all discounted at 3.5%-and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted, as well as scenario analyses. In the model, patients on rivaroxaban plus ASA lived for an average of 14.0 years with no IS/MI/ICH, and gained 9.7 QALYs at a cost of £13 947, while those receiving ASA alone lived for an average of 12.7 years and gained 9.3 QALYs at a cost of £8126. The ICER was £16 360 per QALY. This treatment was cost-effective in 98% of 5000 iterations at a willingness-to-pay threshold of £30 000 per QALY.

Conclusion: This Markov model suggests that rivaroxaban 2.5 mg bid plus ASA is a cost-effective alternative to ASA alone in patients with chronic CAD or PAD.

Keywords: Coronary artery disease; Cost-effectiveness; Peripheral artery disease; Rivaroxaban.

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Figure 1

Model diagram. The patient enters the model in the event-free health state. When the first event happens, the patient progresses to one of the health states ‘1st acute event’, and experiences one of the three events. Following the ‘1st acute event’ phase, the patient transitions to one of the health states ‘1st post-acute event’. The patient can remain in the current health state or experience a second event and transition to one of the health states ‘2nd acute event’. Following the ‘2nd acute event’ phase, the patient transitions to one of the health states ‘2nd post-acute event’. The patient can transition to the ‘Death’ state from every state in the model. ALI, acute limb ischaemia; ICH, intracranial haemorrhage; IS, ischaemic stroke; ISTH, International Society on Thrombosis and Haemostasis; MI, myocardial infarction; VTE, venous thromboembolism.

Figure 2

Deterministic sensitivity analysis—Tornardo diagram on ICER for rivaroxaban 2.5 mg bid in combination with ASA 100 mg od vs. ASA 100 mg od alone. ASA, acetylsalicylic acid; CV, cardiovascular; HR, hazard ratio; ICER, incremental cost-effectiveness ratio; ICH, intracranial haemorrhage; IS, ischaemic stroke; MI, myocardial infarction; QALY, quality-adjusted life-year; RIV, rivaroxaban.

Figure 3

Probabilistic sensitivity analysis—incremental cost-effectiveness plane for rivaroxaban 2.5 mg bid in combination with ASA 100 mg od vs. ASA 100 mg od alone. q, quartile; QALY, quality-adjusted life-year.